| NPI | 1720248206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 14038) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2010-0739) |
| 207Q00000X Family Medicine (Licence: FL ME 109981) | |
| 207Q00000X Family Medicine (Licence: PA MD443512) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2018-02-08 |